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Adèle Ehongo,1 Artémise Dugauquier,1 Nacima Kisma,1 Viviane De Maertelaer,2 Brenda Nana Wandji,1 Wilfried Tchatchou Tomy,1 Yassir Alaoui Mhammedi,1 Kevin Coppens,3 Karelle Leroy,4 Francoise Bremer1 1Ophthalmology Department, Erasmus Hospital, Brussels, 1070, Belgium; 2Biostatistics, IRIBHM Université Libre de Bruxelles, Bruxelles, 1070, Belgium; 3Cosma consulting Sijsjesdreef 13, Enghien, 7850, Belgium; 4Laboratory of Histology, Université Libre de Bruxelles, Bruxelles, 1070, BelgiumCorrespondence: Adèle Ehongo, Ophthalmology Department, Erasmus Hospital, Route de Lennik 808, Brussels, 1070, Belgium, Tel +3225553114, Fax +3225556737, Email adele.ehongo@erasme.ulb.ac.bePurpose: Myopic eyes combining gamma peripapillary atrophy and peripapillary staphyloma were sorted according to the presence of intrachoroidal cavitation (PICCs) or its absence (combinations). Visual field defects (VFDs) and factors discriminating these groups were analyzed.Methods: These groups were sorted by optical coherence tomography. VFDs were assessed using the Humphrey® Field Analyzer 3, SITA standard. Ovality index (OI) was the ratio between the shortest and longest diameters of the disc. The proportions of PICCs, lamina cribrosa defects (LCDs) and clusters in each Garway-Heath’s sector (A—F) were analyzed. All variables were compared between PICCs and combinations. A multivariate logistic regression analysis was performed ultimately.Results: Of the 93 eyes, we obtained, 20 PICCs and 73 combinations. The prevalence of VFDs and LCDs in PICCs were 65% (13/20) and 30% (6/20), respectively. PICCs 85% (17/20) and LCDs 12% (11/93) predominated in sector B (inferotemporal) and clusters 9.7% (9/93) in the corresponding sector. The proportion of VFDs was significantly higher in PICCs than combinations (p < 0.001). In sector B, the proportion of LCDs was significantly higher in PICCs than combinations (p = 0.011). The mean OI was significantly lower (p < 0.001) in PICCs than combinations. Multivariate logistic regression analysis concluded that mean OI (p < 0.001) was the only statistically significant factor discriminating PICCs and combinations.Conclusion: Mean OI discriminating PICCs from combinations is further evidence of a gradation of structural changes between them. It could be related to the higher proportion of VFDs in PICCs. The predominant distribution of PICCs infero-temporally supports PICC as a cause of uncertainty in glaucoma diagnosis in high myopia. Furthermore, the highest proportion of PICCs and LCDs in this sector highlights its vulnerability to damage in myopic eyes and deserves further investigation as it is also primarily involved in glaucoma.Keywords: peripapillary intrachoroidal cavitation, visual field defects, peripapillary staphyloma, gamma peripapillary atrophy, ovality index, lamina cribrosa defects, glaucoma, myopic complications

Adèle Ehongo,1 Noélie Bacq,1 Nacima Kisma,1 Artemise Dugauquier,1 Yassir Alaoui Mhammedi,1 Kevin Coppens,2 Françoise Bremer,1 Karelle Leroy3 1Ophthalmology Department, Erasmus Hospital, Brussels, 1070, Belgium; 2Statistician, Cosma Consulting, Enghien 7850, Belgium; 3Histology Department, Erasmus Campus, CP 620, Université Libre de Bruxelles, Brussels, 1070, BelgiumCorrespondence: Adèle Ehongo, Ophthalmology Department, Erasmus Hospital, Route de Lennik 808, Brussels, 1070, Belgium, Tel +3225553114, Fax +3225556737, Email adele.ehongo@erasme.ulb.ac.beAbstract: Purpose: To compare the peripapillary polar characteristics in eyes combining peripapillary staphyloma and gamma peripapillary atrophy according to whether peripapillary intrachoroidal cavitation (PICC) was present or absent (combination-group).Patients and methods: This prospective non-interventional cross-sectional study included 667 eyes of 334 subjects. From the polar peripapillary regions to the opening of Bruch’s membrane, the following elements and their topographic relationships were analyzed using optical coherence tomography sections: configuration of the posterior curvature of the choroid, visibility of the subarachnoid space (SAS), and suprachoroidal detachment (SCD). Chi-squared and Fisher exact tests were used for statistical analysis.Results: The protrusion of the posterior choroidal wall, with anterior elevation on either side, observed in both groups progressed and transformed into a wedge-shaped deformity on the side of gamma peripapillary atrophy. This wedge configuration was significantly more frequent in PICC-group than in combination-group (p = 0.004 and p < 0.001) for the upper and lower poles, respectively. SAS was more frequently observed in PICC-group than in combination-group (p = 0.002 and p < 0.001) for the upper and lower poles, respectively. SCD was detected exclusively in PICC-group (p < 0.001, both poles). The wedge-shaped configuration and the SCD were aligned antero-posteriorly with the SAS.Conclusion: We confirmed that PICC is an SCD. We observed its constant alignment with the SAS. We suggest that the tensile forces of the optic nerve sheaths during adduction promote the collapse of the scleral flange onto the SAS, leading to PICC. Further studies are warranted to confirm this hypothesis.Keywords: peripapillary intrachoroidal cavitation, suprachoroidal detachment, gamma peripapillary atrophy, staphyloma, subarachnoid space, myopic complications

Abstract To keep up with the contemporary health landscape, there is an imperative need for healthcare professionals to practise health advocacy through health promotion on the individual, population, and systems levels. In the Academic Year of 2020/2021, the National University of Singapore (NUS) Department of Pharmacy implemented a new spiral curriculum integrating basic, clinical, and systems sciences with one of its aims to deepen students’ health advocacy internalisation and prepare them as future health advocates. A mixed-methods approach was adopted. Questionnaires were disseminated across three time-points to elicit students’ levels of internalisation of health advocacy, which were then categorised into levels, and a Mann–Whitney U test was conducted. In comparison with prematriculation, no significant difference was found after students underwent the first year of the curriculum, while a significant difference was found after students underwent two years of the curriculum. Semi-structured interviews were also conducted after each Academic Year to gain deeper insights into the questionnaire results. Thematic analysis of the interviews revealed that curricular integration in the first year was perceived to be lacking. However, with learnt knowledge constantly reinforced and more experiential learning opportunities incorporated throughout the second year, students found the integrated curriculum beneficial in instilling confidence to practise health advocacy. This study offers insights into the prospects of a spiral integrated curriculum in imparting health advocacy, and may even suggest its potential to be applied to other educational settings. Future follow-up studies can also be conducted on the same study population to evaluate long-term impacts and areas for improvement of the curriculum.